Two Real Examples Drawn from More Than 14,000 Patients in Clinical Studies

1

Standard Practice Today

Patient’s Starting Condition
The patient was previously diagnosed with severe coronary artery disease and his vascular condition was quickly deteriorating. Based on normal range levels of HbA1c, he appeared to be treated adequately. The patient did not have diabetes.

Standard Practice Today

weight (kg)

blood pressure

HbA1c (%)

Patient

99

135/85

5.6

Normal

< 90

115/80

< 5.5

hsCRP mg/L

proinsulin pmol/L

adiponectin mg/L

Patient

Normal

2

IR2Dx TIGAR™ Results

The physician ran the TIGAR™ biomarkers and found the patient’s underlying pathways deteriorating. His very high level of hsCRP indicated that his current drug treatment was not working as well as expected. The patient also had very low adiponectin and very high proinsulin levels. Overall, the results confirmed underlying cardiovascular inflammation, and also showed advanced insulin resistance and significant loss of metabolic regulation. These conditions increased the likelihood of conversion to diabetes, or other significant clinical events.

Standard Practice Today

weight (kg)

blood pressure

HbA1c (%)

Patient

99

135/85

5.6

Normal

< 90

115/80

< 5.5

Selected IR2Dx TIGAR™ Marker Results

hsCRP mg/L

proinsulin pmol/L

adiponectin mg/L

Patient

7.3

17.2

4.8

Normal

< 1.0

3 - 8

> 10.0

IR2Dx TIGAR™ Markers Reveal Deteriorating Pathways

Elevated cardiovascular risk

Active lipid tissue

Severe β-cell dysfunction

3

Superior Drug Strategy

The physician decided to continue the patient on aspirin and lipid lowering therapy for cardiovascular disease. A low dose insulin sensitizer was added, which is an insulin resistance and diabetes medication with cardiovascular action. The patient also initiated a low carbohydrate diet.

Standard Practice Current Therapy

Continue atorvastatin

Continue aspirin

Using IR2Dx TIGAR™ Results
Physician Modifies Patient Therapy

Continue atorvastatin

Continue aspirin

Add pioglitazone

Start low carbohydrate diet

4

Better Patient Outcomes

Six months later,all parameters improved dramatically to within the normal range for the three biomarkers. Specifically, the cardiac marker hsCRP moved well within its normal range, despite a very minimal drop in weight or blood glucose levels. The IR2Dx TIGAR™ Report provided the tools for the physician to better guide treatment and optimize therapy for this patient.

Standard Practice Today

weight (kg)

blood pressure

HbA1c (%)

Initial

99

135/85

5.6

RESULT(6-mo later)

97

125/80

5.4

Normal

< 90

115/80

< 5.5

IR2Dx TIGAR™ Biomarker Results

hsCRP mg/L

proinsulin pmol/L

adiponectin mg/L

Initial

7.3

17.2

4.8

RESULT(6-mo later)

0.9

4.2

14.3

Normal

< 1.0

3 - 8

> 10.0

1

Standard Practice Today

Patient’s Starting Condition
The patient was obese and under long-term treatment of diabetes. She had a moderately elevated, stable HbA1c and good blood pressure. Her condition was slowly deteriorating.

Standard Practice Today

weight (kg)

blood pressure

HbA1c (%)

Patient

87

125/80

6.8

Normal

< 60

115/80

< 5.5

hsCRP mg/L

proinsulin pmol/L

adiponectin mg/L

Patient

Normal

2

IR2Dx TIGAR™ Results

The physician ran the IR2Dx TIGAR™ biomarkers, which included hsCRP, proinsulin and adiponectin, and found severe deterioration of the underlying pathways, showing both cardiovascular inflammation and advanced insulin resistance. Thus, despite a superficial stability, the patient’s condition greatly increased her likelihood of having deteriorating health, and significant clinical events, such as a stroke.

Standard Practice Today

weight (kg)

blood pressure

HbA1c (%)

Patient

87

125/80

6.8

Normal

< 60

115/80

< 5.5

Selected IR2Dx TIGAR™ Marker Results

hsCRP mg/L

proinsulin pmol/L

adiponectin mg/L

Patient

5.9

23.3

7.1

Normal

< 1.0

3 - 8

> 10.0

IR2Dx TIGAR™ Markers Reveal Deteriorating Pathways

Elevated cardiovascular risk

Active lipid tissue

Severe β-cell dysfunction

3

Superior Drug Strategy

On the basis of very high TIGAR™ biomarker levels, the physician changed the patient’s medications, and the patient began a low carbohydrate diet program. The physician dropped glimepiride, which essentially only manages glucose levels, continued metformin, and added two more targeted medications – liraglutide, which targets beta cell function in the pancreas, and pioglitizone, which is beneficial for beta-cell function, insulin resistance and cardiovascular risk markers.

Standard Practice Current Therapy

Continue metformin

Continue glimepiride

Using IR2Dx TIGAR™ Results
Physician Modifies Patient Therapy

Continue metformin

Stop glimepiride

Add pioglitazone

Add liraglutide

Start low carbohydrate diet

4

Better Patient Outcomes

Six months later, the patient’s weight dropped significantly, and all of the TIGAR™ biomarkers moved to within normal levels, indicating greatly improved function. As an added benefit, there was a positive movement in the patient’s plasma glucose levels (HbA1c). The IR2Dx TIGAR™ Report aided the physician to better guide treatment and optimize therapy.